Healthy communication;
Translators for patients who don't speak English often are in short supply

By: By Ann Potempa, Anchorage Daily News - March 12, 2002 Tuesday

Chong Vang moved his family to Anchorage because he thought the change in
environment might help his wife's diabetes. When the family arrived from
California five months ago, Vang and his wife, Ia Vue, went to the Anchorage
Neighborhood Health Center. The Hmong couple tried to communicate on their own,
but Vue doesn't know any English and Vang knows only small words. After two
visits, the health center physicians asked if they wanted an interpreter. Vang
and Vue didn't even know that was an option. The next time they came in, so did
Mindy Moua, a Hmong interpreter from Anchorage. With Moua present, Vue realized
why she'd been feeling so bad. The label on her bottle of diabetes pills read,
"Take one tablet by mouth twice daily." Vue misunderstood and took both pills at
once. That made her feel shaky and weak. She struggled to concentrate. She
didn't like the side effects, so she stopped taking the pills. Moua helped Vue
realize she should be taking one pill in the morning and one at night, which
eased the side effects. The Anchorage Neighborhood Health Center clinics in
Fairview and Mountain View have only three interpreters other than Moua,
speaking Chinese, Russian and Thai, said Lynn Upton, the center's operations
director. And it's not a problem only for medical providers. Alaska's public
defenders sometimes struggle to find interpreters for their clients. Public
defender Barbara Brink has sometimes had to call on church organizations and
community groups. Yolanda Salazar Hobrough, a free-lance interpreter from
Vancouver, British Columbia, who translates in Anchorage's federal court system,
is surprised by the lack of interpreters here. She said she's worked with
interpreters flown in from as far away as Florida. Some medical offices hire
doctors who can speak two languages; public defenders use long-distance numbers
to get translation over the phone. Sometimes family members, even kids, end up
translating. Joan Fisher, executive director of the Anchorage Neighborhood
Health Center, said clinics like hers need to do better. To do that, they must
have access to medical interpreters who speak Spanish, Tagalog, Korean, Samoan
or Hmong. They must find interpreters who understand medical terms and patient
confidentiality. Fisher and Salazar Hobrough have teamed up to teach them.
People interested in becoming medical interpreters can attend an orientation
session Saturday at the University of Alaska Anchorage. Salazar Hobrough will
talk about medical interpreting and give a written test. "You really have to be
able to read the language as well as interpret the spoken word," Fisher said.
Those who pass that test will be invited back to take an oral test. Those who
pass both tests will be eligible for a 48-hour training course sometime this
spring or early summer.

FOLLOWING THE LAW Medical facilities that receive grants or other federal
financial aid must provide equal access to English and non-English speakers or
run afoul of the Civil Rights Act of 1964. The Anchorage Neighborhood Health
Center, which receives $2.5 million in grant money annually as well as Medicare
and Medicaid reimbursements, is required to comply. Fisher admits some doctors
consider this law an unfunded mandate. She understands that providing
interpreters can get expensive, but there's more to it than money. "We're
probably the poorest clinic in town, but it's the law," she said. About
one-third of the center's 17,000 patients last year had limited English-speaking
skills. Fisher remembers how some of those patients walked into the clinic
without an appointment only to discover that no one speaks their language. "This
one poor man came five times before we could figure out what language he was
speaking," Fisher said. Some who struggle with English end up avoiding the
doctor. When Helen Lee moved to Anchorage last fall she got a message from her
mother, Wai, who used to live in Hong Kong and now works as a medical
interpreter in Minnesota. One of Wai's old clients had moved to Anchorage but
kept calling Wai for help, even though they lived thousands of miles apart. "She
said she didn't know where to go," Wai said. Wai asked her daughter to call the
woman and help her. Lee learned the family hadn't seen doctors because they
didn't know whom to call. Hmong families in Anchorage likewise have had to take
the initiative. Newcomers seeking translators have searched through the phone
book for a Hmong last name. Moua said some have found her that way.

ROOM FOR MORE Health facilities in Anchorage are providing translation in
different ways. The Alaska Native Medical Center and Providence Alaska Medical
Center say their interpreter programs meet their needs. Indian Health Services
pays the cost of hiring three advocates who can interpret for any Yup'ik patient
at Southcentral Foundation's Primary Care Center and the Alaska Native Medical
Center. Angie Peterkin, support coordinator, said the advocates visit every
inpatient room daily and attend doctor appointments when needed. They work full
time and carry pagers so an interpreter is available 24 hours a day. Peterkin
said the interpreters specialize in Yup'ik because it's the prevalent language
among Native patients with limited English. Interpreters also are available to
help people who speak Inupiaq. Providence hospital keeps a list of people on
staff and in the community who can interpret. If physicians can't find an
interpreter, they call a telephone service, said Karina Jennings, hospital
spokeswoman. The Anchorage Neighborhood Health Center also uses a long-distance
telephone service that offers translation in 120 languages. "That works in a
pinch, but that really is not the best way," Fisher said. Translator phone lines
can be costly. The health center pays $1.95 a minute for its service, said
operations director Upton. Fisher said she'd prefer to use more trained
interpreters. During the past eight months, the health center spent almost $
7,000 to hire interpreters, Upton said. This option is more expensive than using
family members who volunteer to help, but Upton believes patients are better
served by interpreters who aren't related to them. "Children should never have
to be put into a position where they're interpreting for a parent or an adult,"
she said. Children or other relatives might filter the information, not telling
the doctor the whole story. Sometimes they don't know enough medical terms to
tell the story accurately. Other times, relatives aren't comfortable talking
about health problems in front of family. "If you're talking about something
embarrassing, do you want your 9-, 10- or 11-year-old to hear it?" Fisher said.
If a Hmong mother was worrying about a lump in her breast, she might not want to
tell her child that, Moua said. Even if she did say something, the child could
be too embarrassed to translate it. Moua said independent interpreters like her
offer something children can't. "I'm an adult," she said. "I will tell them to
speak freely. I will translate what they will say to the doctor." Moua said more
and more Hmong families are moving to Anchorage; Vang and Vue guessed some of
them are suffering without interpreters, just as they did before meeting Moua.
Moua admits she could use some help from other medical interpreters. There's
room for more, she said.

Reporter Ann Potempa can be reached at adn.com or 907-257-4581.

BECOME AN INTERPRETER The Anchorage Neighborhood Health Center is organizing
an orientation and training program for medical interpreters. The $35
orientation will be 9 a.m. to 1 p.m. Saturday in Room 101 of the Business
Education Building at the University of Alaska Anchorage. A written exam will be
given. Those who pass will be invited back for an oral exam. People who pass
both exams can attend a 48-hour training course that will begin this spring or
summer. The cost for the training course has not been set, but scholarships may
be available. The center wants people to register for Saturday's orientation as
soon as possible. Forms can be picked up at the center's administrative offices,
903 W. Northern Lights Blvd., Suite 218. For more information, call
907-792-6538.
GRAPHIC: Anchorage Daily News Ia Vue, left, and her husband, Chong Vang, have
medical forms explained to them by Hmong interpreter Mindy Moua at the Anchorage
Neighborhood Health Center in Fairview.Moua, right, regularly helps people whose
lack of English skills causes them difficulty in getting health care., Photos By
Bob Hallinen